Frequently Asked Questions

This section includes the most common questions we receive from new patients who are just learning about Prolotherapy, as well as from those who are about to start treatment and have questions about what to expect during the treatment series. Within the answers, we have linked to pages with much more detailed explanations and research if you want to dive further into the topic. If your questions are not answered in this section, please try the search box, or feel free to Contact Us directly. We want to make your trip to our clinic as smooth as possible, and also help you best understand your condition and how Prolotherapy can potentially provide a cure, so you can optimize your results!

Prolotherapy compared to other treatments you have probably already tried

What is H3 Prolotherapy?

Caring Medical Regenerative Medicine Clinics is known for a unique method of Prolotherapy, termed H3 Prolotherapy. It is named after the lineage of doctors who pioneered and continued to advance the most comprehensive injection technique of Prolotherapy: Drs. Hackett, Hemwall, and Hauser. Each physician has made unique and significant contributions with research and clinical results in thousands of cases, starting with George Hackett, MD and Gustav Hemwall in the 1950s through the 1990s, and continuing with Ross Hauser, MD from 1993 through today. Because the term “Prolotherapy” can describe numerous types of regenerative injection treatments, not all techniques are equal. We see many patients here after they have tried single shot PRP, stem cells, or other types of Prolotherapy without long-term results. The goal of H3 Prolotherapy is to treat the area aggressively enough to give more desirable long-term results. Learn more about the history of H3 Prolotherapy.

While these treatments pair very well together, physical therapy (PT) primarily concentrates on strengthening muscles, and Prolotherapy strengthens and repairs ligaments. At the root of chronic pain is joint instability, which is caused by loose ligaments (the structures that hold joints together). It is not a muscle problem, though muscles become involved eventually to help stabilize the joint because the ligaments are too loose to do so. Loose ligaments cause destructive joint forces, resulting in symptoms like pain, bone spurs, swelling, and muscle spasms. Ultimately, the destructive joint forces cause cellular death and joint/cartilage/disc/labrum/meniscus degeneration. Prolotherapy is the only treatment for loose ligaments.

How is H3 Prolotherapy different than an amniotic stem cell injection?

Amniotic stem cells are donor cells and have been freeze-dried, stored, and reconstituted prior to use. In the end, there are no live cells being injected. When Caring Medical does a stem cell treatment, we take your live, fresh stem cells directly from you and use them in your treatment that day. They are then injected in and around the joint, along with traditional H3 dextrose Prolotherapy to the supporting joint structures, as well as performing a nerve release or treatment of inflamed nerves in the area, when appropriate.

Additionally, stem cell treatments are touted as a one-shot wonder. Please understand that there are no shortcuts to treatment, especially something as serious as osteoarthritis. If someone tries to give you one, they are just plain ol’ wrong. Your joint is literally dying (think “necrosis” or “gangrene”). The reason that joint replacement has to happen in some cases is that the joint tissue is literally destroyed and cartilage cells have drowned to death. It is very serious and can have devastating consequences. Without treating the joint comprehensively, long-term results are not likely and have not yet been shown effective in long-term studies. On the other hand, many studies have proven with thousands of patients over the decades that Prolotherapy is effective because of the more comprehensive injection technique. It is exactly the purpose of H3 Prolotherapy.

How is Prolotherapy different than cortisone?

In short, cortisone accelerates joint damage whereas Prolotherapy protects and strengthens joint structures. Cortisone covers up pain signals and decreases inflammation. When you block pain, your body cannot tell you it hurts. This creates a vicious cycle of joint damage because you will not alter your activity level and end up doing additional damage to your joints because there isn’t a pain signal trying to warn you about further damage happening in the joint. There are many studies explaining the degenerative effects of cortisone, and most surgeons will even admit that during surgery, they can tell the difference between a joint that has received cortisone injections and one that has not. Prolotherapy aims to correct joint instability, thereby alleviating pain and destructive joint motion. Instability is progressive, meaning if left untreated, the instability gets worse! When the instability gets worse, so does the pain. Therefore, as you keep getting cortisone shots, it does not cure your pain—it simply covers it up while the joint damage accelerates.

How is Prolotherapy different than hyaluronic acid / viscosupplementation / Synvisc®?

The “roostershot” as many people have called it is a temporary cushion that many people use to try and delay joint surgery. Prolotherapy, on the other hand, is a permanent way to avoid surgery altogether. By stabilizing the joint and correcting why it was breaking down in the first place, the cartilage can repair instead of die, which is what happens to cartilage cells when you have osteoarthritis- they die by drowning. Sorry to break it to you, but hyaluronic acid doesn’t stop that. Prolotherapy is the only injection treatment proven to aid in cartilage repair because it corrects the root cause of the problem.

Being a candidate for Prolotherapy

I’ve been told I’m a slow healer. Will I still be a candidate?

Absolutely! No two bodies, or immune systems, are exactly alike. Some people do heal faster than others, but that doesn’t mean you can’t be pain free too! You can maximize your healing and minimize the number of treatments needed to become pain free by following any requests or recommendations your provider makes. Your provider will discuss with you things that may help increase your healing ability, such as natural hormone replacement therapy, proper nutrition, stress reduction, and other things that can help your immune system perform at its best so you can reach your goals with Prolotherapy.

Shouldn’t I do PRP or stem cells instead of Prolotherapy?

PRP and stem cells are a type of prolotherapy solution, just like dextrose is. Prolotherapy is the term used for the injecting of proliferating solutions (proliferant therapy = Prolotherapy). Not all patients need PRP or stem cells, many are cured of their instability and pain with dextrose solution. Based on the severity of your instability, functional goals, and other considerations, your provider will discuss with you the most appropriate solution for your individual case.

Are my stem cells old or diseased?

Although stem cell numbers decrease as we age, bone marrow and adipose (fat) still have high numbers of stem cells. We have successfully used stem cells and other Prolotherapy solutions to cure patients of all ages.

Do I need to change my lifestyle or eating habits to receive Prolotherapy?

Let’s be honest, we all probably eat things we shouldn’t. A healthy and nutritious diet leads to a healthy body. This doesn’t mean you can never eat cake, it simply means you need to give your body the fuel it needs to heal. Lean proteins and fresh fruits and vegetables are something we all benefit from. The foods we eat give our bodies certain things we need to heal, so a healthy and balanced diet is an important part of healing. If your main food groups are Doritos and Mountain Dew, we need to talk.

Why do you keep talking about joint instability? That is not what my MRI shows.

What your MRI shows is the results of joint instability. That slipped disc or herniated disc is caused by instability! If your ligaments were tight, the disc would not be able to come out of place. Once your ligaments become stretched out, the disc is able to slip out of position. MRI’s are a good tool for certain things, but since you are not moving during an MRI, it does not show the instability in a joint. Digital Motion X-ray and ultrasound are good tools for showing instability because they show the joints while they are moving and you can see the instability.

How do the treatments help nerve pain? I thought Prolotherapy was just for joint pain and arthritis?

Instability causes nerve pain. When the ligaments are stretched and the joint is unstable, the bones can hit the nerves and irritate them, causing nerve pain. Over time, this constant bumping of the bone into the nerve causes the nerve to become swollen and irritated, leading to constant pain. Prolotherapy strengthens the joint and prevents the bone from bumping the nerve.

How do the treatments help headaches?

Often, headaches are caused by instability in the neck. When the ligaments that hold the vertebra in the neck together get stretched out from looking down at a computer or phone, or stretched or damaged from an accident, the muscles tighten up to try to hold the vertebra in place. This muscle tightening causes a lot of stress and strain in the neck and at the base of the skull, and this leads to headaches. The upper vertebra in the neck can also become turned to the side a little bit when the ligaments are unable to hold them together, and this rotation can push up against a nerve causing headaches, face pain, jaw pain, even ringing in the ears. Prolotherapy tightens the ligaments and this allows the muscles to relax and the headaches, and other pains, go away.

Can I receive Prolotherapy if I’m taking medications?

Our clinical team will review your medication list during your New Patient phone consultation and advise if there is anything that should be discontinued, such as NSAIDs or narcotic pain killers. In general, most medications that are unrelated to pain, such as hormone therapy or blood thinners, are fine to continue throughout the Prolotherapy treatment series. Again, for specific medication questions, our clinical team will review your medication list prior to your first appointment and advise.

Do I need to have tests performed before I can come in for a consultation and Prolotherapy?

No. Having the opportunity to talk with you about your case and conduct a physical exam is the first step toward pain relief. Doing additional testing without first having a thorough consultation and physical exam is putting the cart before the horse. If you already have imaging results from other providers, we are happy to review it, but we can provide most of the imaging needed in our office or we will refer you to have a specific test based on your physical exam and history during your initial consultation.

Do you treat adolescents?

Yes, we treat young patients all the time. Some of the primary diagnoses we treat with Prolotherapy for children include Ehlers-Danlos syndrome and osteochondritis dissecans, among others. Our providers specialize in treating the cervical spine, which is also one of the reasons some of our patients travel here, including kids. If your child has chronic pain, sports injury, chronic subluxations from Ehlers-Danlos syndrome, and/or neurological issues from cervical spine instability please reach out to us through the clinical intake form on those linked pages to tell us more about their case via email info@caringmedical.com. Our clinical team will review your child’s case to see if it sound like a good fit for our clinic!

Am I too old for Prolotherapy?

Most likely you are not too old for Prolotherapy if you are in relatively good health and able to travel to our clinics. We have treated patients in their 80s and 90s to help relieve pain and keep seniors more active and independent. The loss of mobility due to chronic pain can have disastrous effects for an elderly person, as they can quickly lose their independence and develop other very serious health concerns. The risks involved with surgery may mean it is not an option at a certain age, and other popular options of pain pills or cortisone only further the downward spiral of pain and disability. If this is what you or a loved one is facing, please reach out to us about your case. We would love to help you restore your function and mobility! Prolotherapy is a regenerative option that is a great alternative to surgery for seniors with chronic pain.

Your first Prolotherapy visit / initial consultation

How would you diagnose me without an MRI?

It is misleading to think that MRI is necessary when you have a chronic pain. A well-trained pain practitioner knows when MRI is warranted, and when it is really just a waste of money. In our office, a thorough physical exam and history are paramount. After that, ultrasound, and Digital Motion X-ray (DMX) offer insights that are not seen on an MRI. With 27+ years of experience, the providers at Caring Medical recognize instability by the way your joints feels and responds when they put it through a gentle range of motion during the physical exam. Musculoskeletal ultrasound and DMX allows us, and you, to actually see the instability in your joints in motion, which is actually when most people experience symptoms, not while lying flat. However, an MRI would be ordered by your Caring Medical provider anytime it is deemed necessary to rule out significant conditions or obtain additional information that would increase your chance for better results.

Do I need to bring in my X-rays, MRIs, EMGs, and old records?

You can certainly bring any radiologic imaging that you have already had performed. If you do have imaging results, please bring a copy of the disc for us to keep on file, as well as the written report. It is not necessary to have an MRI or other tests prior to your appointment, unless you have been otherwise instructed to do so by your medical provider. Results of recent lab work, done within the last six months, may be brought to your visit if you feel they are pertinent to your current condition.

Should I eat before my appointment?

Yes, you must eat before receiving Prolotherapy. Please eat a good-sized breakfast with protein before coming in for a morning appointment, and eat a good-sized lunch with protein before coming in for an afternoon appointment. The only exception is if you are scheduled to have treatment under conscious sedation. For these instances, you will not eat prior to your appointment. You will be talking with a clinical member prior to your appointment to review any additional instructions.

How long is the visit?

The average new patient visit is approximately 2-3 hours for a single joint and more straightforward cases of injury and arthritis. If you have a complicated multi-joint case or end up receiving Stem Cell Prolotherapy, the visit will run closer to 3-4 hours. For single joint and straightfoward cases, the follow-up visit duration is approximately 1 to 2 hours. Complex head/neck cases that require Digital Motion X-ray exam/guidance, as well as most multi-joint EDS cases, will likely be in the office for 4-6 hours during the first visit and approximately 3-4 hours for follow up treatment visits, depending on the extent and severity of your condition.

Will I get Prolotherapy on the first visit?

If the reason you are coming to Caring Medical is to receive Prolotherapy (this includes PRP, Stem Cell therapy, Nerve Release, etc..) you will most likely receive it, provided that your body can physically handle it. If your Prolotherapy specialist feels that your general health is too poor, he or she may suggest certain laboratory testing first. This is rare. The majority of patients are able to receive Prolotherapy the first visit. This is part of the reason why our new patients have a clinical call prior to the first in-office visit, so we have a better understanding ahead of time about your current health status and extent of your pain condition.

While we are not a part of any insurance networks, Caring Medical will provide you with detailed invoice that can be submitted to a private, non-HMO insurance company for possible reimbursement at the “out of network” rate. The invoice will reflect that you paid in full and reimbursement should be sent directly to the primary/patient. Invoices can NOT be submitted to government-based insurance plans such as Medicare, Medicaid, Tricare, or to HMO plans. Some specific services are not billable to insurance, including some stem cell therapy.

If you have a Health Savings Account (HSA) or Flexible Spending Account (FSA), these are great payment options for regenerative medicine treatments!

Most of our patients report at least some coverage/reimbursement on Prolotherapy treatments. We cannot, however, guarantee any insurance reimbursement because most insurance company policies only offer pain medication and cortisone, or some physical therapy, for chronic pain treatments. Unfortunately, this perpetuates chronic pain cycles and opioid dependence in many patients who do not look outside insurance for better answers. This is probably why you are on our site right now- avoid surgery and a lifetime of pain medication. Caring Medical’s philosophy is to get people out of pain and off pain medications and pain “management” treatments. Our goal is to CURE pain, and it can be accomplished in most cases we see. Therefore, we cannot participate in programs that pay providers to give drugs and treatments that advance joint degeneration, like cortisone injections. We simply know better!

Do I talk with the doctor before coming into the office?

Our team has been trained to assess the basics of your case to determine if you are a good fit to consult with our providers. Most of our patients have been deemed “complex” by their local PCP or specialists, but are very usual for our clinics to handle each day. By explaining your case to our team members, you will be properly scheduled according to the details of your case. Once scheduled, our team will arrange for you to speak with one of our clinical team who works very closely with our providers to gather your medical history and answer some general questions. There are instances where telemedicine/online visits with our providers are recommended before a patient comes into the office so the provider can meet you and assess your case directly. Patients who have a highly complex upper cervical or full-body case, as well as those traveling in from out of town, are most likely to start a teleconsultation.

After receiving Prolotherapy

When can I work after Prolotherapy?

Most of our patients go back to work the next day. Some even go back the same day, especially if they had an area treated that would not be aggravated by their job. However, it is important to let your provider know what type of work you do and the physical activities your job entails, as they may want to limit certain things based on your particular case, or they may have you wear a certain brace or protect the joint in some other way to maximize your treatments and ability to heal.

Can I drive after treatment?

Many of our patients drive themselves after treatment. There are a few things to keep in mind when deciding if you should ask a friend or family member to either accompany you or pick you up. If you are a neck patient or a right knee/hip/ankle/foot patient, we recommend having a driver for your comfort as the motions required for safe driving may be slowed down for a few hours due to the treatment. Also, patients that request medications for comfort during treatment are required to have a driver. All sedation patients (offered in Florida office only) are required to be accompanied to their appointment by an adult that will be with them for 24 hours.

Can I travel home after treatment?

If you are driving a long distance (over a few hours) or have to take a plane to travel home, we highly recommend staying overnight at local accommodations after the first visit. In addition, if you are receiving stem cell therapy, you should plan to stay overnight locally. This will make the treatment experience much more pleasant, as it can be intense if this is your first time receiving a comprehensive Prolotherapy treatment. Of course, after your first treatment, it will be easier for you to determine if staying overnight for subsequent treatments is necessary. For anyone receiving Prolotherapy to only one area, like a knee, traveling home the same day will be much easier than someone receiving Prolotherapy to the cervical spine and/or multiple body areas. You can discuss this with our team directly for a recommendation on your specific case.

When can I exercise after Prolotherapy?

Exercises is good! We aim to get you back to your active lifestyle as quickly as we can while optimizing your healing. Your provider may even have a few new exercises they want you to do at home or with your trainer or physical therapist. We recommend you take it easy for the first few days after a treatment. This doesn’t mean be a couch potato! Activities of daily living are great. It simply means no heavy workouts for the first few days. More specific instructions will be provided to you during your visit and written in your treatment plan.

Adjunctive treatments and availability

Do I continue physical therapy?

This is something your provider will determine. Some of our patients benefit from physical therapy (PT) later in their course of treatment while others do excellent with home exercises prescribed by the provider. Depending on the severity of your instability, your joints may not be ready for PT. For many people who have tried rounds of physical therapy already, this may be the case. Until the ligaments are in a state of repair, physical therapy will continue to be frustrating and lack long-term effectiveness because it is not addressing the root cause of the problem. PT may try to address muscle imbalances but those cannot be fixed until the ligaments that actually create the joint are restored. For patients who will benefit from a combined approach, we will work with your therapist on developing a program that will be most effective for you.

Can I continue seeing my chiropractor?

We do not recommend high-velocity chiropractic adjustment for our patients. In many cases, these types of adjustments aggravated the current condition by further loosening the ligaments, worsening joint and spinal instability. However, we love chiropractors as much as most of our patients and many offer adjunctive treatments that can pair well with Prolotherapy. Every case is unique, and determinations about adjunct care are determined by the provider. We may recommend a specific type of chiropractic care based on your individual treatment plan. Your treatment plan is customized to you and may be different from others.

Why can’t I get these injections at my other doctor’s office?

Prolotherapy is more than just “shots.” It is a highly specialized procedure. To cure pain, you need a Prolotherapist who understands the importance of a comprehensive approach and knows that just injecting one or two ligaments, or just an intra-articular injection, is not generally enough. Becoming a high-level Prolotherapist takes time and training under another high-level Prolotherapist to learn this technique. Not just attending a weekend course on theory or with cadavers. Patients who have more complicated cases and/or are serious about Prolotherapy need a provider that specializes in Prolotherapy and that has been trained thoroughly in ligament anatomy and does not solely rely on guidance from a machine. Dr. Hauser, our Medical Director, learned from the pioneers of Prolotherapy, Drs. Hackett and Hemwall. Thus, H3 Prolotherapy is what we practice here, and what he taught to all of our Prolotherapy providers in addition to their other medical training in both traditional and regenerative pain treatments.

My doctor said Prolotherapy isn’t going to help me.

Many doctors do not fully understand how Prolotherapy works, or even worse, have never heard of it! They may assume that one shot of PRP or amniotic cells is the same as H3 Prolotherapy. If they think Prolotherapy is new, it shows they do not understand the decades of research and patient results supporting its use in chronic pain, sports injuries, and arthritis. Because it is a specialized treatment, providers must take it upon themselves to learn after graduating. It is a huge undertaking to do it the right way, just as is any medical sub-specialty. Thus, it is typically not well understood by doctors who do not specialize in chronic pain care, or who have only tried one-shot PRP.

Prolotherapy treatment goals and results

Do you need to keep working?
Don’t want to quit sports?
Want to be mobile again?
Let’s get started!

What is considered a pain cure?

The average cure rate for excellent candidates is 90%; good candidates is 75%; poor candidates is 10%. The reason H3 Prolotherapy is so successful is that it has a solid foundation which has only been improved as technology advanced over the past 65 years in treating over 40,000 patients. It involves ideal patient selection, treatment method and follow up. Remember, helping soften the symptoms of chronic pain is easy, resolving chronic pain is not. The world’s most scientifically curative regenerative injection method is Caring Medicals H3 Prolotherapy Method. Simply it involves treating all of the appropriate joint instabilities and optimizing appropriate forces on the injured structures throughout the healing process. A person is deemed cured of their pain when three criteria are met:

90%+ of their symptoms are resolved

They are back to full activity

There is objective evidence that the joint instabilities are resolved

Is this just to help postpone surgery?

No! Prolotherapy is the preferred alternative to surgery, eliminating the need for surgery in most cases. Many of our patients have been told they need joint replacements, the dreaded “bone on bone”. We treat patients that have been told they are “bone on bone” on a regular basis with fantastic results! These patients are currently walking, jogging, playing tennis and golfing on a regular basis without surgery!

What happens if I don’t get complete relief after the first treatment?

Don’t get discouraged! Just because you do not notice immediate relief, does not mean nothing is happening. It takes time for your body to heal, and each treatment builds on the one prior. Think of it as building a house; you have to build the foundation first. It may not look like much progress, but without the foundation, you can’t build the house. The first treatment is the foundation, the base for all of your other treatments and the first step toward curing your pain!

Why does the Prolotherapy series take more than one treatment?

Ligaments are white tissues, this means they have a poor blood, and nutrient, supply. Since these tissues have a poor supply of what they need to heal, they are slow to heal. Prolotherapy causes inflammation at the ligaments, which initiates the healing cascade in the area. This inflammation tells the body there is tissue damage, and the body begins to send the additional nutrients and healing cells that are needed to tighten and strengthen the ligaments.

Follow up is crucial with Prolotherapy, and this is when it matters most to work with an office that does Prolotherapy full time. We cannot tell you how often we hear from patients who received Prolotherapy, PRP, stem cells elsewhere and were sent away without any follow up plan. If this is you, please realize that we cannot give you specific recommendations. You need to come to our clinic and we will provide you with more specific details on how to best reach your functional goals and rehab your joint. For instance, whether or not to brace the area, what type of brace, how long to wear it, etc… When it comes to exercise, we make specific recommendations on what type of exercises, when you are allowed to graduate from cycling to jogging to running, etc… We work with you on specific supplements or other healing aids that can help boost or speed your response to Prolotherapy.

The Prolotherapy treatment series is 50% us and 50% you. We will give you the most comprehensive treatment techniques during your visit and recommend a home care plan and/or adjunctive treatment plan for you to work on after treatment. The combination is highly successful, and it is why patients from all walks of life travel to our clinics. Whether your goal is to be able to play with your kids or grandkids, hike the Appalachian trail, run your PR marathon, return to work full-time, avoid a career-compromising surgery, enjoy retirement, or stop your pain medication dependency, we want to help you succeed!